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Pre-authorisation agent for Nammed

The pre-authorisation agent for Nammed gathers what a pre-authorisation needs before a planned procedure.

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Riverside Family ClinicPre-authorisation agentWhatsApp
  1. Customer: I need a knee scope next month. What do I do?
  2. Read the plan’s authorisation rulesNammed
  3. Pre-authorisation agent: You’ll need authorisation before you’re admitted. Your plan guide asks for the doctor’s quote with the procedure codes and the hospital’s name. Do you have the quote?
  4. Customer: I’ll send a photo.
  5. Quote received: codes and hospital foundHealth Loops
  6. Complete request sent to the authorisation team
Sample conversation. People, brands and figures are made up.

What it can do with Nammed

  • Reads the Nammed authorisation rules for the member’s plan and gathers what they need
  • Match the member to their Nammed option from the 6 on file (Basic, Active, Essential and 3 more), with their membership number, from a message or a photo of their card
  • Answer what the member’s option covers from the Nammed plan guide, with the figures for their option and the source shown
  • Read a claims or benefit statement the member sends and explain each line still owed, in plain words

Tools.

NammedLiveWhatsAppLiveEmailLiveDiscovery HealthLiveVoice and phone callsLive

Questions

What does the pre-authorisation agent do with Nammed?

Reads the Nammed authorisation rules for the member’s plan and gathers what they need.

Is the Nammed connector live?

Yes.

Does the pre-authorisation agent approve procedures?

No.

Does the agent decide Nammed claims or authorisations?

No.

Does the agent triage or diagnose patients?

No.

Ollie’s agents give wellness guidance. They don’t diagnose or prescribe, and hand off to a human expert when needed.

The pre-authorisation agent by vertical

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The pre-authorisation agent with other connectors